Following a period of public consultation on the draft MCP contract framework, NHS England has published the first version of a model contract for accountable care organisations (ACOs) for use by both Multi-Speciality Community Provider (MCPs) and Primary and Acute Care System (PACS) led models in the NHS.
NHS England has published a draft contract and supporting documents as the next step in bringing into force population-based models of care through the commissioning of integrated hospital and community health services from an ACO. As anticipated the contract is set out in the same way as the NHS Standard Service Contract but with a greater focus on long-term population and system outcomes.
Whilst the scope of each ACO is likely to vary all accountable models will build on strong primary care foundations and the contract is drafted to provide for a distinction between levels of service integration. Similar to the draft MCP contract framework this is provided for by way of a fully, partially or virtual integrated ACO model:
- Fully-integrated model – the ACO operates as a single organisation as lead provider for all community and core primary care services for the entire area to which the contract relates. Under this model GPs would be released from their current GMS, PMS or APMS contractual obligations and instead may relate to the ACO as a co-owner, employee or sub-contractor.
- Partially-integrated model – the ACO operates all services in scope of the fully-integrated model excluding the provision of core primary care services. The contract will instead refer to the integration of its community services with core primary care by way of an Integration Agreement. NHS England has published a draft template Integration Agreement for partially integrated ACOs which is intended to create a framework for the parties to work collaboratively through shared governance and decision making and the integration of services.
- Virtual model – the virtual model does not create an ACO but sees local community service providers and commissioners enter into an Alliance Agreement which would overlay (but not replace) existing commissioning contracts. NHS England has published a draft template Alliance Agreement for parties to establish a commitment to manage and deliver services operationally as well as to form clear governance and gain/risk sharing arrangements.
The contractual approaches through which accountable models are established focus heavily on the requirement for providers to deliver services tailored to the individual needs of the ACO population, for example the requirement to report on national outcome and process indicators. Successful integration will be measured by way of the Incentive Framework. This aims to assist the ACO in identifying best practice and evaluating the impact on health services through the publication of provider outcome performance and the establishment of the Improvement Payment Scheme.
The development of the ACO contract framework remains an iterative process and the Department of Health is expected to publish a revised and final set of Directions relating to contracts for accountable care later this year.